Key findings: P0309.3 – Mortality and causes of death in South Africa, 2021: Findings from death notifications

This report provides information on levels, trends and patterns in mortality and cause of death by socio-demographic and geographic characteristics. The mortality and cause of death indicators presented in this report are critical for measuring the health status of the South African population. The main focus of this report is on 2021 death occurrences, however, information on deaths that occurred during the period 2000 to 2020 is included to show trends in mortality.

The total number of deaths recorded for 2021 was 613 720. The trend analysis shows that, except for 2020 and 2021, the country's overall mortality rates have been declining since 2007. Between the years 2000-2002 and 2010-2021, non-communicable diseases accounted for more deaths, although a decrease in these figures was noted from 2019 to 2021.

The occurrence of deaths differed by age and sex in 2021. The age group 65–69 years, had the highest proportion of deaths at (9,7%), while the age group 5-9 years had the lowest at (0,4%). Disaggregation by sex shows that in 2021, there were more male deaths than female deaths from age 0 to age group 60−64; whereas female deaths exceeded male deaths from age 70 years and above. The median age at death was 57,3 years for males and 64,9 years for females. The results further indicate that in the past five years, 2019 and 2021 had the highest death sex ratio (186 male deaths per 100 female deaths) observed, which was for the age group 20−24 years. The provinces with the highest proportion of deaths were Gauteng (22,6%), KwaZulu-Natal (18,6%) and Eastern Cape (14,1%). The province with the lowest percentage of deaths was the Northern Cape (3,1%).

The leading cause of death in South Africa in 2021 was COVID-19 at 15,1%. Ranking second and third were diabetes mellitus (6,0%) and hypertensive diseases (4,9%). Eight of the top ten leading causes of death were the same for both sexes, although with different rankings. COVID-19 (14,2%), diabetes mellitus (4,5%) and cerebrovascular diseases (3,9%) were the leading underlying causes of death for males. Whereas COVID-19 (16,0%), diabetes mellitus (7,5%) and hypertensive diseases (6,3%) were the leading underlying causes for females. The most notable movement among the underlying causes of death was seen in tuberculosis, which dropped from second place in 2019 to fifth place in 2020 and seventh place in 2021.

Deaths due to non-natural causes were higher for males than females, with the proportion significantly high for males aged 20-24 years. Assault (10,9%), transport accidents (10,5%) and event of undetermined intent (6,8%) were the three leading non-natural causes of death in the country in 2021. Kwa-Zulu Natal had the highest percentage of deaths due to external causes of death and injuries at 11,3%, followed by Eastern Cape and Western Cape.